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Query: UMLS:C0033377 (prolapse)
 11,717 document(s) hit in 31,850,051 MEDLINE articles (0.00 seconds)

From 1964 to 1973, 50 patients who initially underwent ileostomy for inflammatory bowel disease at the Lahey Clinic required 84 revisions. The commonest reason for revision was stenosis. Fistula, prolapse, and retraction followed in order of frequency. Patients with Crohn's disease seemed to have a higher incidence of revision, but this was not statistically significant. Other reasons for revision were analyzed, and recommendations for treatment were discussed. Retrospective study revealed that 50% of ileostomy revisions were performed for probably preventable complications.
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PMID:Ileostomy complications requiring revision: Lahey clinic experience, 1964-1973. 84 90

This report provides our personal experience along with a general overview of the use of the circular stapler in rectal surgery. To determine the results of our experience with the use of the circular stapler for construction of anastomoses following resection, a series of 215 anastomoses performed in 214 patients was reviewed. The patients ranged in age from 33 to 88 years. There were 116 men and 98 women. Indications for operation included malignancy, diverticular disease, villous adenoma, Crohn's disease, and rectal procidentia. The types of operation performed included removal of varying portions of the large bowel. The anastomosis was performed in a uniform manner with the EEA (United States Surgical Corp., Norwalk, CT) and more recently the CEEA (United States Surgical Corp., Norwalk, CT). The operative mortality was 0.47 percent, with the death being unrelated to the anastomosis. Intraoperative complications encountered included bleeding, difficult extraction, instrument failure, incomplete doughnuts, deficient anastomoses, and miscellaneous problems. Early postoperative complications included one leak and a number of complications unrelated to the anastomoses. Anastomotic stenosis developed in 27 patients, but only 8 were permanent and only 3 of these were symptomatic. Two of these patients were treated with balloon dilatation. Anastomotic recurrences developed in 13.1 percent of patients. Our experience gained with the circular stapling device and that reported in the literature have shown it to be a reliable method of performing anastomoses to the rectum in a safe and expeditious manner.
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PMID:Experience with the use of the circular stapler in rectal surgery. 161 60

Two patients with atrial fibrillation had abrupt onset of abdominal pain and massive small bowel distension suggesting mesenterial artery embolism. One patient had dilation of the left atrium and ventricle, the other a mitral value prolapse syndrome with a dilated left atrium. Both patients were treated conservatively and gradually recovered. A small bowel series performed several weeks after the acute episode showed loss of normal mucosa and narrowing of a long segment of the small bowel. A control examination in one patient one year later, still revealed jejunal mucosal abnormalities and stenosis, features similar to those occurring in Crohn's disease. Our observations suggest that analogous to ischemic colitis, an entity of acute ischemic small bowel enteritis exists. Mesenteric ischemia apparently can induce a clinical syndrome of "regional enteritis". The radiologic features should not be confused with those of Crohn's disease.
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PMID:Acute small bowel ischemia without transmural infarction. 195 43

Indications for ileostomy revision in 49 patients with inflammatory bowel disease operated upon between January 1975 and December 1984 were obstruction (15), retraction (10), parastomal hernia (9), prolapse (8), and fistula (4). Recurrent Crohn's disease was an important factor in the pathogenesis of ileostomy complications particularly obstruction, retraction and fistula. Local revision without laparotomy was successful in seven of eight patients with an ileostomy prolapse, but in only four of eight patients with a retracted stoma. Results of local repair without laparotomy and resiting were successful in five of six patients with a parastomal hernia. Laparotomy was usually necessary in patients with obstruction especially if there was underlying Crohn's disease and in patients with peristomal fistula. Resiting of the stoma after laparotomy was used only if the stoma site was outside the rectus muscle or if the original stoma site was infected.
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PMID:Indications and outcome of reoperation for ileostomy complications in inflammatory bowel disease. 336 Dec 22

The clinicopathologic features of nine patients with inflammatory polyps of the anorectal transition zone (inflammatory cloacogenic polyp, ICP) were reviewed. All polyps were characterized histologically by crypt hyperplasia and a thickened muscularis mucosa arising beneath a surface epithelium consisting of variable proportions of squamous, columnar, and often transitional epithelium. Tubulovillous architecture was characteristic. Sialomucin predominated over sulfomucin in eight of nine cases. One polyp displayed focal dysplasia and condylomatous features, while two others had associated hemorrhoids. Three cases had been previously diagnosed as adenomas. Seven patients were women, and two were men; their median age was 54 years (range, 17 to 85). Clinical presentation was most commonly intermittent rectal bleeding, and the clinical diagnosis was anal polyp or hemorrhoids in all cases. Six patients had the solitary rectal ulcer syndrome (SRUS) and/or evidence of mucosal prolapse. Papillomavirus was demonstrated by histochemical and immunohistochemical methods in one case in which multiple foci of dysplasia were also noted. Two patients had Crohn's disease, and the remaining patient had a coexistent adenocarcinoma located several centimeters proximal to his ICP. The pathologist and clinician must be aware that although ICP is often associated with SRUS/mucosal prolapse, it may occur in other clinical settings.
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PMID:Inflammatory cloacogenic polyp: relationship to solitary rectal ulcer syndrome/mucosal prolapse and other bowel disorders. 350 Jan 6

During a period of 10 years (1980-1990) we constructed or reconstructed 358 end-ileostomies: 224 were primary constructions, 96 were reconstructed by laparotomy, and 38 were local reconstruction. Only 2 ileostomies were primarily located on the left side. The mean length was 5 cm. We had 11.6% reoperations after primary stomy and 7.3% and 7.9% reoperations after reconstruction by laparotomy and local approach, respectively. There were 12.9% and 8.7% reoperations after emergency and elective primary operations, respectively. Closing the lateral gutter or fixation of ileum to the rectus fascia did not influence significantly the number of reoperations. Postoperative discolored stomy did not indicate more dysfunction of the ileostomy. Stenosis of the ileostomy, peristomal fistulas, and peristomal dermatitis were seen in 23 (10.3%), 21 (9.4%), and 18 (8%) of the patients after primary ileostomies, respectively. Patients with Crohn's disease had significantly more of these problems than patients with ulcerative colitis. Only a few patients had retraction of the ileostomy (2.7%), stomal prolapse (1.8%), or parastomal herniation (1.8%). Women had significantly more parastomal herniation than men; otherwise there were no differences between the sexes.
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PMID:Technical aspects and complications of end-ileostomies. 767 12

Stomal complications of ileostomy may occur many years after construction. An actuarial analysis of complications of 150 permanent end ileostomies constructed over a 10-year period is reported. By 20 years the incidence of stomal complications approached 76 per cent in patients operated on for ulcerative colitis and 59 per cent in those with Crohn's disease (P < 0.05). Revisional surgery rates were higher in patients with ulcerative colitis than in those with Crohn's disease (28 versus 16 per cent), albeit not significantly. The four commonest complications were skin problems (cumulative probability 34 per cent), intestinal obstruction (23 per cent), retraction (17 per cent) and parastomal herniation (16 per cent). Closure of the lateral space did not reduce the probability of developing intestinal obstruction (18 per cent at 20 years in those with closure versus 3 per cent in those without, P > 0.1). Fixation of the mesentery did not reduce the probability of developing prolapse of the ileostomy (11 per cent in those with fixation versus none in those without, P < 0.1). The incidence of parastomal herniation was not reduced by sitting through the rectus abdominis (21 per cent in those sited through the body of the rectus abdominis versus 7 per cent in those sited through the oblique muscles, P < 0.1). Some of the surgical dogmas relating to ileostomy construction are not supported by the results of this study.
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PMID:Life-table analysis of stomal complications following ileostomy. 804 64

This study was undertaken to prospectively assess all morbidity and mortality associated with temporary loop ileostomy. Eighty-three consecutive patients of a median age of 45 years required temporary fecal diversion after either ileoanal or low colorectal anastomosis (n = 72), for perianal Crohn's disease (n = 5), or for other reasons (n = 6). All loop ileostomies were supported with a rod, and fecal diversion was maintained for a mean of 10 weeks. To date, 67 patients have had re-establishment of intestinal continuity. Stoma closure was affected through a parastomal incision in 64 patients; in three, a laparotomy was required. The closure was stapled side to side in 49 patients, while a hand-sewn anastomosis was done in the other 18 patients; all skin wounds were left open. The mean length of surgery for ileostomy closure was 56 minutes, and the mean hospital stay was five days. Nine patients (10.8 percent) developed 10 complications, nine of which required hospitalization. Specifically, four patients developed dehydration and electrolyte abnormalities secondary to high stoma output, and two had anastomotic leaks that spontaneously healed following conservative management. One patient developed a superficial wound infection that spontaneously drained itself. One patient developed a partial small bowel obstruction that resolved without surgery after a four-day hospitalization. One stoma retracted after supporting rod removal and prompted premature closure. There was no stomal ischemia, hemorrhage, prolapse, or mortality in this series. Thus, loop ileostomy is a safe way to achieve fecal diversion.
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PMID:Loop ileostomy is a safe option for fecal diversion. 845 60

Endoscopic ultrasound (EUS) was designed for the evaluation of malignancies; however, its utility has been extended to the assessment of benign disorders, which include inflammatory bowel diseases. Topics discussed in this article include instruments and methods, EUS images in various inflammatory diseases, clinical severity and EUS typing, endoscopic grading of inflammation and EUS typing, extent of disease involvement and EUS typing, response to therapy and EUS typing, changes in EUS findings by treatment, Crohn's disease, radiation proctitis, ischemic colitis, tuberculosis, and mucosal prolapse syndrome.
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PMID:Endoscopic ultrasonography in inflammatory bowel diseases. 853 34

Exenterative pelvic surgery is commonly performed for advanced carcinoma of the cervix and selected cases of locally advanced colorectal cancers. Low-lying lesions that are locally invasive in contiguous organs require resection of the perineal body en bloc with the resected specimen. The resulting defect, both in the pelvis and the perineum, creates a difficult management problem. Dead space in the pelvis, especially with adjunctive irradiation, leads to delayed wound healing and prolapse of small bowel into the pelvis. Small bowel obstruction and/or fistula formation are the greatest sources of morbidity in the operative group. Fifteen patients underwent exenterative pelvic procedures (total exenteration, 1 patient; posterior exenteration, 8 patients; abdominoperineal resection, 6 patients). All patients were reconstructed by transpelvic placement of the rectus abdominis muscle (muscle only, 4 patients; muscle with skin grafting, 8 patients; musculocutaneous, 3 patients). Eighty-seven percent received radiation therapy. One patient had Crohn's disease and all others had carcinoma. Healing was complete in 12 of 15 patients at discharge. There were no complications related to pelvic dead space (i.e., bowel obstruction, perineal fistula), with a mean follow-up time of 24.3 months. Small bowel was effectively excluded from the pelvis to the level of the acetabular roof by computerized axial tomography scan. The transpelvic rectus abdominis muscle flap is effective in preventing major morbidity after exenterative pelvic surgery.
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PMID:Reconstruction of pelvic exenterative wounds with transpelvic rectus abdominis flaps: a case series. 904 79


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